Abstract
AbstractPurpose Diffuse iris or ciliary body (‘ring’) melanoma is still considered an indication for enucleation. We perform proton beam irradiation of the whole anterior segment as an alternative, conservative treatment for these eyes with often good vision.Methods Since 1992 we treated more than 70 patients with total anterior segment irradiation, 60 of whom presented primary diffuse iris and/or ring melanoma. We studied local tumor control, eye retention probability, final visual acuity, radiation induced side effects and their management.Results Local tumour control was 100%. Three eye were enucleated. Vision was influenced by tumor and radiation induced side effects such as cataract, intraocular hypertension and ocular surface toxicity. Their management consisted of phacoemulsification, trabeculectomy, deep sclerectomy or tube surgery and preventive limbus deposition and reposition (LDR).Conclusion Proton beam irradiation of the whole anterior segment is a safe alternative to enucleation in diffuse iris or ring melanoma. Management of actinic cataract, glaucoma and ocular surface toxicity through modern techniques is essential for maintaining the eye and a useful vision.
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